Table 1.

Summary of cases with myasthaenia gravis (MG) and antiphospholipid antibody syndrome (APAS)

Study author and year Patient’s age and sex	Progression of symptoms	Diagnostics for APAS and MG	Medical management	Other therapeutics and comorbid autoimmune conditions
Shoenfeld et al 9 20/F (1997)	Initial: MG symptoms of extremity weakness Interim: 3 years APAS: two abortions, one stillbirth, ischaemic stroke left MCA territory, spleen artery obstruction	(+) Anticardiolipin antibody (moderate to high positive titers) (+) Repetitive nerve stimulation (+) Anti-AChR	Warfarin	(+) Thymectomy: onset of APAS symptoms is 2 years after the procedure (+) Thymus hyperplasia Maintained on an INR of 3.0–4.0: a lower target still resulted in spleen artery obstruction
Watanabe et al 10 40/F (1997) Article in Japanese Abstract retrieved	Initial: APAS symptoms of miscarriage and pulmonary embolism Interim: 13 years MG: diplopia, ptosis and fatigability	(+) Anticardiolipin (+) Lupus anticoagulant (+) Tensilon test	Aspirin (low dose)	(+) Thymectomy: Symptoms of APAS ameliorated after the procedure
Kaji et al 11 47/F (2002)	Initial: MG symptoms of generalised weakness Interim: 17 years APAS: phlebothrombosis of the left lower extremity and ischaemic stroke left and right MCA	(+) Anti-β2 glycoprotein-I antibody (IgG high titer) (+) Anti-AChR	Prednisolone Pyridostigmine Urokinase Heparin Warfarin	(+) Thymectomy: onset of APAS symptoms is 7 years after the procedure Urokinase and heparin were given 4 days after stroke onset and continued for 2 weeks Warfarin given for 1 month only because of bleeding
Bhinder et al 12 43/F (2005)	Initial: MG Interim: not specified APAS: ischaemic stroke and femoral artery thrombus	(+) Anticardiolipin (+) Anti-AChR (+) Repetitive nerve stimulation	Azathioprine Prednisone Warfarin Pyridostigmine	(+) Thymectomy: onset of APAS symptoms is after the procedure (+) SLE was the first disease diagnosed 10 year follow-up with well-controlled disease
Dan et al 13 42/F (2014)	Initial: APAS symptoms of three abortions Interim: not specified MG: diplopia, ptosis, dysphagia and fatigable chewing	(+) Anticardiolipin antibodies (IgG and IgM low positive titers) (+) Anti-β2 glycoprotein-I antibodies (IgG and IgM moderate to high) (−) Anti-AChR (+) Repetitive nerve stimulation (−) Anti-MuSK	Azathioprine Prednisone Pyridostigmine Aspirin (81 mg daily)	(−) Thymoma (+) Transient hypothyroidism
Miskovic et al 25 48/F (2015)	Initial: MG Interim: 28 years APAS: pulmonary embolism	(+) Anticardiolipin antibody (IgG and IgM moderate to high positive titers)	Unspecified anticoagulant Mycophenolate mofetil Prednisone	(+) Thymectomy: onset of APAS symptoms is 28 years after the procedure (+) SLE: diagnosed at the same time as APAS
Minchenberg et al 14 58/F (2018)	Initial: APAS presenting with stroke Interim: not specified MG: bilateral ptosis and diplopia	(+) Lupus anticoagulant (−) Anticardiolipin (−) Anti-β2 glycoprotein-I antibody (+) Anti-AChR	Treatment for APAS and MG not specified	(+) SLE diagnosed after APAS-related stroke (+) Hydroxycholoroquine for SLE
Minchenberg et al 14 57/M (2018)	Initial: APAS presenting with pulmonary embolisms Interim: not specified MG: symptoms of ptosis, diplopia fatigue and weakness	(+) Lupus anticoagulant (−) Anticardiolipin (−) Anti-β2 glycoprotein-I antibody (+) Anti-AChR	Mycophenolate mofetil Cholinesterase inhibitor	(+) SLE diagnosed at the same time as APAS Weakness responded to mycophenolate but not to cholinesterase inhibitor (+) Hydroxycholoroquine for SLE
Diestro et al 46/F (2019) Present case	Initial: MG ptosis, three episodes of crisis Interim: 4 years APAS: stroke, left MCA territory	(+) Lupus anticoagulant (−) Anticardiolipin (+) Anti-AChR (−) Anti-MuSK	Warfarin Alteplase	(−) Thymoma (+) Intrevenous thrombolysis done for ischaemic stroke while admitted for MG crisis

AChR, acetylcholine receptor; INR, international normalised ratio; MCA, middle cerebral artery; MuSK, anti-muscle-specific kinase; SLE, systemic lupus erythaematosus.